Problems, challenges and successes at the pilot sites
Gauteng
There is keen interest from top management in the programme, and a desire to see a gradual expansion of PMTCT sites. The existence of an experienced medical doctor as part of the management team is a strength. At regional and site level, management appears to be much weaker with a great deal of tension between roleplayers. Three counsellors per site (R500 per month).
Natalspruit: Natalspruit hospital and J Dumane community health center (CHC)
- 300 booking visits per month
- 60-80% uptake of HIV testing
- 33% HIV positive
- 96% exclusive formula feeding
- 3% exclusive breast feeding
Kalafong: Kalafong hospital and Pretoria West maternity and obstetrics unit (MOU)
- 300 booking visits per month
- Less than 60% uptake of HIV testing
- 43% HIV positive 85% exclusive formula feeding
- 15% exclusive breast-feeding
Western Cape
The PMTCT programme in the province precedes the national pilot programme with the Khayelitsha services starting in January 1999. The Chief Director for HIV/AIDS has been very involved in initiation, development and implementation of PMTCT programme, together with a strong team. Little privacy in the Gugulethu clinic. 14 lay counsellors (R2 500 per month).
Gugulethu: Gugulethu MOU and 8 clinics in Nyanga district
- 380 booking visits per month
- More than 80% uptake of HIV testing
- 21% HIV positive
- 95% exclusive formula feeding
- 4% exclusive breast feeding
Paarl: Paarl hospital, TC Newman CHC and 17 surrounding clinics
- 270 booking visits per month
- More than 80% uptake of HIV testing
- 8% HIV positive
- 73% exclusive formula feeding
- 27% exclusive breast feeding
Northern Province
Provincial restructuring and administrative problems have delayed the implementation. Intensepressure was put on Mankweng by the MEC to start and to date there are no lay counselors and only 6 of the 19 facilities prepared when it started. There is tension and disagreements among the provincial roleplayers, hampering progress. Mankweng is poorly designed for the PMTCT programme. No counselors.
Mankweng
Mankweng hospital and 19 clinics (many of which are small, isolated, under-resourced and understaffed)
- 725 booking visits per month
- Less than 60% uptake of HIV testing
- 17% HIV positive
- 73% exclusive formula feeding
- 7% exclusive breast feeding
Siloam (started in November 2001) : Siloam hospital and 6 out of 17 clinics (some of which are small, isolated, under-resourced and understaffed)
- 80 booking visits per month
- Less than 60% uptake of HIV testing Training of staff had not started by November.
- Doctors perceived as being too busy to be trained.
Mpumalanga
The area of HIV/AIDS seems to be characterized by underlying tension, confusion, disagreement and a lack of coherent leadership. This has led to low morale among senior managers. The person heading the PMTCT programme as an education background with little health care experience. Nurses with other duties and responsibilities are expected to implement the PMTCT services. Lebohang had no space for counseling and three toilets were converted. 13 counsellors, none at Evander. (no pay)
Shongwe: Shongwe hospital and 9 out of 23 surrounding clinics
- 100 booking visits per month
- Less than 60% uptake of HIV testing
- 47% HIV positive
- 74% exclusive formula feeding
- 26% exclusive breast feeding
Evander: Evander hospital, Lebohang CHC and Embalenthle clinic
- 140 booking visits per month
- Less than 60% uptake of HIV testing
- 39% HIV positive
- 89% exclusive formula feeding
- 11% exclusive breast feeding
Free State
The province is blessed by a stable leadership with the MEC providing dynamic leadership to the health department as well as the PMTCT programme in particular. Mostly group counseling with individual counseling offered. 26 lay counsellors (R500 per month).
Virigina
Virginia hospital and 8 clinics
- 340 booking visits per month
- Less than 60% uptake of HIV testing
- 32% HIV positive
- 77% exclusive formula feeding
- 23% exclusive breast feeding
Frankfort
Frankfort hospital and 8 clinics
- 200 booking visits per month
- Less than 60% uptake of HIV testing
- 23% HIV positive
- 68% exclusive formula feeding
- 32% exclusive breast feeding
KwaZulu-Natal
Both sites have established good teams involving all the required roleplayers. There is active support from the head of department and the MEC. The problem of unstable staff means that there is a constant need to provide training. Space and privacy are problems. 30 counsellors (R2 800 per month).
Durban
King Edward VIII hospital and KwaMashu Polyclinic, Prince Mysheni hospital and feeder clinics in Section D and K, Umlazi
- 1 000 booking visits per month
- More than 80% uptake of HIV testing
- 44% HIV positive
- 40% exclusive formula feeding
- 42% exclusive breast feeding
Pietermaritzburg
Grey’s Hospital, Northdale Hospital and Sabantu and Northdale clinics, Edendale Hospital and Imbalenhle and Taylors Halt clinics, Church of Scotland Hospital
- 725 booking visits per month
- 60-80% uptake of HIV testing
- 34% HIV positive
- 65% exclusive formula feeding
- 35% exclusive breast feeding
Eastern Cape
Strong management is provided by the Director: HIV/AIDS, however, in the last two years the province has been troubled by unstable senior management. This has led to low morale. Rietvlei’s poor physical infrastructure and physical inaccessibility poses a major challenge. Most of the feeder clinics are in a poor state of repair and are small and cramped. Some clinics in the area are not even proper, formal structures. Lack of privacy for counselling. 216 lay counsellors (voluntary).
East London complex
Frere Hospital and 29 clinics, Cecilia Makiwane Hospital and 19 clinics
- 950 booking visits per month
- Less than 60% uptake of HIV testing
- 25% HIV positive
- 69% exclusive formula feeding
- 31% exclusive breast feeding
Umzimkulu Sub-district Rietvlei Hospital and 12 clinics (many of which are small, isolated, under-resourced and understaffed)
- 70 booking visits per month
- More than 80% uptake of HIV testing
- 35% HIV positive
- 54% exclusive formula feeding
- 46% exclusive breast feeding
Northern Cape
The head of department has been committed to the HIV/AIDS and PMTCT programme. She has helped to fast-track certain actions. Few doctors have been trained. R200 000 worth of renovations were done in record time to prepare the sites. Three lay counsellors per site (R500 per month).
Galashewe
Galashewe Day Hospital, Kimberley Hospital, Masakhane clinic and Roodepan clinic
- 150 booking visits per month
- Less than 60% uptake of HIV testing
- 32% HIV positive
- 82% exclusive formula feeding
- 8% exclusive breast feeding
De Aar
De Aar Day Hospital, Motana clinic, Amalia clinic, Nomzwakazi clinic and one CHC
- 50 booking visits per month
- More than 80% uptake of HIV testing
- 5% HIV positive
- 100% exclusive formula feeding
- 0% exclusive breast feeding
NorthWest
Things are working well at all levels in terms of management. No training of mobile staff. Lehurutshe has inadequate space. In mobile clinics, voluntary counseling and testing is done in cars. Of 19 primary health centers, only 5 have sufficient space, 14 have no space. Poor uptake of voluntary counseling and testing. In Rustenburg nurses are doing the bulk of counseling. In Zeerust 42 lay counselors were trained for voluntary counseling and testing (no pay).
Thlabane
Rustenburg Hospital, Thlabane Health center and 4 clinics
- 100 booking visits per month
- Less than 60% uptake of HIV testing
- 42% HIV positive
- 81% exclusive formula feeding
- 19% exclusive breast feeding
Lehurutshe
Lehurutche District Hospital and 21 surrounding clinics
- 210 booking visits per month
- Less than 60% uptake of HIV testing
- 17% HIV positive
- 79% exclusive formula feeding
- 0% exclusive breast feeding
* Any site managing an HIV testing rate of more than 80% can be considered to be doing “very well”. Sites with a testing rate of 60-80% can be classified as doing “reasonably well”, while those below 60% need to be targeted for extra support.
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Problems, challenges and successes at the pilot sites
by Anso Thom, Health-e News
February 26, 2002
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